Saturday, January 30, 2010

Jurassic Health Care

As is true with any plan where nothing can go wrong, something will go wrong. I don't know what, if anything, will be passed in Congress, but I see several potential problems regardless of the final outcome. Here now is my top ten list of future problems.

1. If the reform involves expanding coverage either with private or public insurance, then the reimburesment rates paid to doctors under the new plans need to be set. If rates are so low that the newly insured still don't have access to health care because no doctors are willing to accept them as new patients, then what is the point.

2. If reimbursement rates under the new plans are sufficient to entice doctors to accept them, then Medicare members, which have lower reimbursement rates, or people that already have insurance start getting left out.

3. If Medicare increases their reimbursement rates to ensure that members maintain their access to doctors, then this will cause the cost of health care reform to go way beyond the original estimates. I believe that this is a major concern. If health care reform is passed, it will be based on cost estimates that are way below what they will end up being.

4. Private insurers may also increase their reimbursement rates so that their customers can maintain access. Any hope of "bending the curve" is lost.

5. The government steps in to ensure that all patients have equal access to doctors regardless of the reimbursement rates offered. Private insurers will lower their rates since their is now no advantage to offering to pay more. At this point doctors basically become government employees and their offices are jampacked with patients making it harder for everyone to get an appointment and see the doctor.

6. Doctors revolt by no longer accepting insurance and moving to a cash only basis. This may not be a bad thing in terms of reducing the costs of health care as much of the cost goes to unnecessary procedures that people wouldn't pay for if they were paying their own bills.

7. The number of students training to become doctors starts falling as a future of dealing with government red tape doesn't seem so enticing.

8. Another part of cutting the costs of health care is implementing cost effectiveness measures in order to cut the extent of unnecessary procedures. These measures may include things such as less frequent mammograms, new guidelines on transplants, and reduced end-of-life care. The determination of cost effectiveness would be made by experts, also known as death panels.

9. I'm acually a big fan of cost effectiveness and support death panels, but affected parties will cry foul on these measures and demand that they be alowed to receive any care approved by their doctor. Government will no doubt relent and pay for less efficient treatments causing costs to go way beyond original estimates.

10. If insurance reform involving guaranteed issue, community ratings, and individual mandates passes, then premiums for healthy people would rise dramatically. Granted, premiums on sicker people would fall, but you are robbing Peter to pay Paul. I don't think anyone disagrees that this would happen. Some people believe that that is a fair tradeoff and some people don't.

About Me

Hi, I'm Dr. Mark A. Swanstrom, CFA and this is my blog. This blog includes essays on current economic, political, and financial issues or whatever else I might be thinking about. I also post parts of the book I'm working on, Kinky Economics. I try to post items twice a week. Please feel free to comment and assist me on this undertaking.